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The buzz about evidence rating

Publish Date: 3/27/2012

“Evidence-based practice should be the new buzzword for the century because it is going to be the foundation of what we do moving through the rest of our practice,” said Paula Graling, DNP, RN, CNOR, during “RPs Next Generation: Rating the Evidence.” Somewhere along the way, nurses have to lose their fear of the word “research,” because evidence-based practice (EBP) is “now an approach to health care where we, as the providers, have to use the best evidence.”

To support this effort, AORN and multiple committee and task force members have selected two models to support the evidence that is presented in each of the AORN recommended practices (RP) documents. The first is the Johns Hopkins evidence rating model, which the team members adapted to be more specific to perioperative nursing. This form is used to independently rate each piece of evidence that is garnered through the rigorous literature search process. After the individual sources are rated, the Oncology Nursing Society PEP (or putting evidence into practice) schema helps the raters use the collective evidence to rate the intervention according to one of six scores, from “recommended for practice,” which means the intervention is effective and has been demonstrated by strong evidence, to “not recommended for practice.”

Many nursing practices actually fall into the category of “effectiveness not established,” which is not a bad thing, Graling said. It just means that there is currently insufficient data or data of inadequate quality to support the intervention. The reason is that much of nursing research evidence is non-experimental or case control studies, case reports, or has conflicting evidence, where the evidence is insufficient to conclusively support a recommendation.

“Our big challenge was to operationalize these high-level principles and rethink how we create the RPs and how we administer them,” said Ramona L. Conner, MSN, RN, CNOR, manager, standards and recommended practices at AORN. The first step was creating the Recommended Practices Advisory Board, which has the responsibility for final approval of the RPs. The next step was establishing the evidence rating process and upgrading the RP authoring system. As part of the upgrade, the team revised the RP format so it would include all of the elements required for the appraisal rating and convey those correctly in the documents themselves.

With all of the evidence rating processes in place, the next progression of AORN RPs will be submitting them to the AHRQ National Guidelines Clearing House. Other professional associations have already taken this step, and by doing the same, AORN will be positioned to maintain its national clout as an authority in safe perioperative practice with the added accolade of also supporting EBP and giving perioperative nurses the resources to justify treatment decisions.

“We as nurses have a professional responsibility to use evidence-based practice,” Graling said. “It’s the buzzword now but it will be the foundation of our practice as we move forward. Rating the levels of evidence provides valuable information to readers and helps with discussions [about practice].”